Clinical Documentation Improvement Specialist

UnitedHealth Group - Baltimore, MD

Full-time | Custom_1
The Clinical Documentation Improvement Specialist (CDIS) conducts medical record documentation and coding quality reviews to ensure accurate and complete coding and documentation of encounter data for Risk Adjustment and Fee for Service product lines. The NPCCR CDIS serves newly hired Advanced Practice Clinicians (APCs) recommending processes for accurate coding and documentation practices through communication and education to ensure compliance with federal regulations, statutes, and the Office of Inspector General.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:
Performs New Provider concurrent Review (NPCCR) in accordance to department policies providing expert coding and documentation coding education, timely feedback, coaching, fostering an environment of learning for new APCs
Works one on one with their Assigned APC team acting as the provider’s coding and documentation educator/mentor
Performs concurrent coding quality reviews for newly hired and contracted APCs (NP, PA, MDs) of 100% of all records until the provider achieves 95% accuracy rate
Provides expert level review of submitted visit notes; identifies gaps in clinical documentation that require clarification for accurate code assignment to ensure the documentation accurately reflects the severity of the condition
Evaluates documentation to ensure that diagnosis coding is supported and meets specificity requirement to support clinical indicators, HEDIS and STARS quality measures including:
Validation of ICD code submissions for accuracy and compliance with Risk Adjustment documentation standards
Review and analysis of clinical documentation for missed HCC coding opportunities
Review and analysis for suspect HCCs/Gaps based on clinical indicators and documentation findings
Queries providers regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the heath record
Performs analysis of coding quality review outcomes and develops formal written performance reports on a weekly basis
Schedules meetings with assigned APCs and delivers one-on-one educational feedback sessions to include review of quality review outcomes and performance
Provides coaching and feedback and develops targeted education and training to provider teams to improve quality, accuracy and overall documentation
Communicates program graduation notification to APC as well as APCs manager
Develops relationships with clinical providers and communicates coding and documentation guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation
Maintains a 96% quality audit accuracy rate

Required Qualifications:
Undergraduate degree in related field or equivalent work experience

Coding Certification from AACP or AHIMA professional coding association (CPC, CPC-H, CPC-P, RHIT, RHIA, CCS, CCS-P, CRC) or RN/LPN with ability to obtain coding certification from AHIMA or AAPC within 12 months of hire

5 years active coding experience with ICD diagnosis coding

3 years Risk Adjustment HCC/Coding/Auditing Experience

2 years’ experience in a coding auditor/educator or mentor role

Experience developing and delivery coding education/training to professionals such as physicians, nurses, nurse practitioners etc

Advanced understand of medical terminology, pharmacology, anatomy and physiology, and pathophysiology

Exemplary attention to detail and completeness with a thorough understanding of CMS regulations and thorough understanding of potential areas of risk for fraud and abuse in regards to coding and documentation

Must be able to maintain professionalism and a positive service attitude at all times

Ability to analyze facts and exercise sound judgment when arriving at conclusions

Ability to effectively report deficiencies with a recommended solution in oral and/or written form

Advanced skill with Microsoft Office applications to include Word, Excel, PowerPoint and Outlook

Preferred Qualifications:
Certification as Certified Risk Adjustment Coder

Experience or Certification as Clinical Documentation Improvement Specialist

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.